Chain of custody record with contact details, Westchester County

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 Sa NYS-ELAP No. 10108 Time/Date Set:_________________________ Form A-70 (rev, 1/96) » ■

Sample Type (circle one): £) Potable 3, Non-Potable Treated Bottle #’s: - A -\ - 2, Non-Potable 4. Other Chain of Custod^^j^ yes no Time/Date Collected: ■ \ X - 1 < ‘ Tj t Comments: Collected By: Agency Code: PWS #:____ Source ID: Type Descriptor: Collected From: k ,5x^56 Bill to: Location's/lndividual’s Name Name/Company Street_____ ;_____ Street■ City/St/Zip_______________ City/St/Zip Identification of Source___:___________ Phone#:__________ _______ Fax Collection Point. QsxS’Us'V). . I CA, CH. Bl?. Check#: Amounts. ' ■■ . )

BACTERIOLOGICAL^^^^,* BACTERIOLOGICAL ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab. (circlo tests) ... .''' (cirr.le tests) ' ) , 1, Heterotrophic Plate'. > ‘ > L Trihalomethanes (524)’ 1. Purgeable Halocarbons (624/8260)"” ■?' , Count (hernodialysis & airothers) ’ ® Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2, Coliform P/A (public supplies) y Cy Volatile Arorhatics^' (524) 3. Acrolein & Acrylonitrile (624) - 3. Coliform MPN (priv well, raw, stp) 4, Total Trihalomethane l^otential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5, Microextractables (504p 5. Organochlorine Pesticides (608/8080) ; - Pesticides (507) 6. PCB's (Arochlors) (608/8080).V ? 5. Microscopic 6. Macroscopic 7. API b Pesticides/PCB screen (508) ' 8, PCB as Decachlorobiphenyl (508A) 7. Herbicides (SM-18/6640; 8151 )>', 8. Other Pesticides (SM-18/6630) . \ 7;

8. Other:. ^ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) ’ ? i © Pesticides (525) 10. Glycols in Water i: 11. Acid Extractables (625/8270) Refrigerated? .yes no 11, Carbamate Pesticides (531) 12, Glyphosate (547) 12. Base Neutral Extractables (625/8270) ... Chlorinated?: yes no r 13, Diquat (549) (^GC/MS'Llnknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L , 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: .mg/L' ■ 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH____ J .■

INORGANIC ANALYSES REQUESTED-^Lab#: ) (circle tests) ’ Jp 1. Color ►‘’ 2b. Acidity . i' / 39k Aluminum 59. Potassium 2. Turbidity . 2.1. Alkalinity, as CaCOa I 40.Wntimony 6O.jSelenium’ 3. pH 22. Spmide j 41.Ursenic ''6lf Silver ■ 4. Conductivity . 23. Bjomate/Chlorate/Chlorite I 42. Barium 62. Sodium 5. Corrosivity (temp: .’C) <^,4. Chloride \4^'Beryllium 63? Thallium 6. BOD (5 day) '25. Cyanide 4^ Boron ,64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium i'65y-2inc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP -. Chemical Oxygen Demand 9. 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N Q^Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31, Nitrogen, Total Kjeldahl as N /sK Cobalt - 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease I 511 Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 152. Iron TCLP 15. Solids. Suspended 34. Phosphorus, Total as P (5^ Lead 71.TCLP-Metals 16. Solids, Total 35, Phosphorus, Ortho as P 54 Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36, Sulfates Zs^wlanganese 73. TCLP-Herbicidos 18. Solids, Total Volatile 37. Surfactants I 56. Mercury 74. TCLP-Volatiles Other: ______ 38. IIV254 1 57. Molybdenum 75. TCLP-BNA’s \ 58/Nickel

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